Neurosurgery
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The pituicytoma is a rare primary tumor of the neurohypophysis. Although histologically benign, the location and vascular nature of these tumors can make surgical resection difficult. We present a report of two patients with pituicytomas and review the literature regarding treatment and prognosis for this unusual lesion. Possible histogenetic relationships of this tumor with other pituitary neoplasms are presented. ⋯ Pituicytomas are a distinct form of pituitary gland neoplasia that may recur if subtotally resected. These neurohypophysial tumors may contain a small subpopulation of previously unrecognized bcl-2-immunoreactive cells, whose role in the histogenesis of pituicytoma deserves further study.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial.
Animal models and clinical studies suggest that intraventricular thrombolysis improves clot resolution and clinical outcomes among patients with intraventricular hemorrhage. However, this intervention may increase the rates of rebleeding and infection. To assess the safety and efficacy of intraventricular thrombolysis, we conducted a pilot, randomized, double-blind, controlled, multicenter study. ⋯ Intraventricular thrombolysis with urokinase speeds the resolution of intraventricular blood clots, compared with treatment with ventricular drainage alone.
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Comparative Study
Pretreatment and posttreatment evaluation of hemodynamic and metabolic parameters in intracranial dural arteriovenous fistulae with cortical venous reflux.
Retrograde drainage into the cortical veins results in poor outcome in patients with an intracranial dural arteriovenous fistula. However, the pathophysiological features of dural arteriovenous fistulae remain obscure. This study aimed to clarify hemodynamic and metabolic conditions in these patients using positron emission tomography. ⋯ The present results suggest that hemodynamic and metabolic characteristics vary widely among patients with cortical venous reflux. It is essential to precisely evaluate hemodynamic and metabolic conditions to predict their outcomes and therapeutic effects.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Grading of subarachnoid hemorrhage: modification of the world World Federation of Neurosurgical Societies scale on the basis of data for a large series of patients.
The goals of this study were to use a large, prospectively collected, multicenter database for patients with aneurysmal subarachnoid hemorrhage (SAH) who were treated between 1991 and 1997 to determine the prognostic significance of clinical and radiological factors for outcomes and to use those factors to develop a grading scale to predict outcomes. ⋯ Outcome prediction after SAH can be improved by adding additional clinical and radiological factors to the WFNS scale, albeit with added complexity.
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Comparative Study
"Tangential" resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach.
Arteriovenous malformations (AVMs) of the medial temporal lobe are usually resected through subtemporal-transcortical approaches that provide a trajectory that is perpendicular to the plane of the AVM. The pterional approach is sometimes used for AVMs in the uncus and amygdala, but it is not recommended for AVMs in the hippocampal region because it provides a "tangential" approach with limited access to posterior feeding arteries and draining veins. The orbitozygomatic approach enhances exposure along this tangential trajectory and was used in a consecutive series of 10 patients to determine its advantages. ⋯ The orbitozygomatic approach maximizes the exposure of the tangential approach to medial temporal lobe AVMs and has advantages over traditional lateral approaches. It provides early access to critical feeding arteries from the anterior choroidal artery, posterior cerebral artery, and posterior communicating artery; it minimizes temporal lobe retraction and risk to the vein of Labbé; and it avoids transcortical incisions or lobectomy that might impact language and memory function. For these reasons, it may be the optimal approach for small- and medium-sized compact AVMs in the dominant medial temporal lobe.